Rheumatoid Arthritis Flashcards by Alice Richards

what genes are associated w. RA

HLA-DRB1

PTPNN22

How well did you know this?

Not at all

Perfectly

RA involves more efficient __ cells

that produce __

T cells

autoantibodies

How well did you know this?

Not at all

Perfectly

3 rf for RA

female

smoker

25-55 yo

How well did you know this?

Not at all

Perfectly

RA pathophys involves the formation of a __

which invades and destroys __

panus

bone and cartilage

How well did you know this?

Not at all

Perfectly

what happens in the preclinical stage of RA

breakdown of tolerance

How well did you know this?

Not at all

Perfectly

3 possible triggers for RA

bacterial antigens

viral antigens

smoking

How well did you know this?

Not at all

Perfectly

RA involves proliferation of

synovium

How well did you know this?

Not at all

Perfectly

RA usually has __ onset

with morning stiffness lasting >__

especially after __

insidious (chronic)

30 minutes

prolonged activity

How well did you know this?

Not at all

Perfectly

RA involves __ swelling of joints

symmetric

How well did you know this?

Not at all

Perfectly

RA is __articular

poly

How well did you know this?

Not at all

Perfectly

joints mc affected by RA

lots of little joints:

PIP

MCP

wrists

ankles

MTP

How well did you know this?

Not at all

Perfectly

RA gets __ w. activity

and OA gets __ w. activity

worse

better

How well did you know this?

Not at all

Perfectly

hand manifestations of RA (3)

ulnar deviation of MCP joints

swan neck deformity

boutonniere deformity

How well did you know this?

Not at all

Perfectly

hyperextension of PIP

flexion of DIP

swan neck deformity

How well did you know this?

Not at all

Perfectly

flexion of PIP

extension of DIP

boutonniere deformity

How well did you know this?

Not at all

Perfectly

extraarticular sx of RA (5)

fatigue, wt loss, low grade fever

rheumatoid nodules

vasculitis

How well did you know this?

Not at all

Perfectly

what is this showing

rheumatoid nodules

How well did you know this?

Not at all

Perfectly

what do you think when you see rheumatoid nodules

pt is almost surely RF (+)

How well did you know this?

Not at all

Perfectly

where are RA nodules commonly found (3)

forearm extensors

over joints

pressure points

+/- lungs, sclerae, other tissues

How well did you know this?

Not at all

Perfectly

describe RA nodules (2)

firm

not tender

How well did you know this?

Not at all

Perfectly

what is this showing

RA vasculitis

How well did you know this?

Not at all

Perfectly

ocular manifestations of RA

keratoconjunctivitis sicca

scleritis/episcleritis

scleromalacia

How well did you know this?

Not at all

Perfectly

what do you think when you see RA and keratoconjunctivitis sicca, +/- xerostomia

secondary Sjorgen’s

How well did you know this?

Not at all

Perfectly

mc pulmonary manifestation of RA

pleuritis

How well did you know this?

Not at all

Perfectly

besides pleuritis, 3 other pulmonary manifestations of RA

pleural effusions rheumatoid nodules interstitial lung dz

cardiac manifestations of RA (3)

chronic inflammation → increased risk for CV dz pericardial effusions pericarditis

what does SANTA make you think of

RA → Felty syndrome

what does SANTA stand for

splenomegaly anemia neutropenia thrombocytopenia arthritis (RA)

in FELTY syndrome, neutropenia could be \_\_ or the pt could have \_\_

asymptomatic frequent bacterial infxns

RA in FELTY syndrome is typically (3)

seropositive erosive severe

what % of RA pt's are seronegative

15%

most specific bloodwork for RA

anti-CCP abs

seronegative RA involves a __ dx

clinical

standard RF panel (5)

anti-CCP RF ESR/CRP CCB CMP

do you need anti-CCP or RF for RA dx

no! *15% of pt's are seronegative*

what might CBC show for RA (4)

mild anemia thrombocytopenia WBC normal mild leukocytosis

what do you think when you see: inflammatory effusion, leukocytosis, PMNs predominate

synovial fluid for RA

in RA, leukocytes are typically between

15,00-25,000

early imaging for RA will likely be

normal

initial signs of radiographic damage w. RA

soft tissue swelling osteopenia around joints

earliest imaging e.o RA is seen in (2)

wrists feet

late imaging findings of RA (2)

joint space narrowing erosions

what categories does the American College of Rheumatology 2010 criteria include (4)

joint involvement serology acute phase reactants duration of symptoms

a score of __ in the American College of RA criteria is diagnostic for RA

diagnostic criteria for RA (5)

inflammatory arthritis involving at least 3 joints RF (+) AND/OR anti-CCP (+) elevated ESR AND/OR CRP duration of at least 6 weeks excluded other causes

3 tx goals for RA

control pain/inflammation preserve fxn prevent deformity

what are DMARDs

disease modifying anti-rheumatic drugs

mc combo pharm tx for RA

MTX (DMARD) PLUS TNF

any pt on combo therapy needs

rheumatologist involvement

screening considerations for RA

hep B & C baseline labs ophthalmic screening **latent TB** **r.o pregnancy** baseline radiographs

baseline labs for RA (5)

CBC Cr LFTs ESR CRP

what pharm may be used for sx of RA, but should never be used as monotherapy

NSAIDs corticosteroids

tx for RA flare ups

steroids

tx for recurrent RA flare ups

increase MTX

what drug alleviates sx of RA AND slows rate of joint damage

corticosteroids

how are corticosteroids used in RA

as a bridge to starting DMARDs ***d.c as soon as possible***

starting bridging steroid and dose for

prednisone 5-20mg/day

methotrexate sulfasazaline hydroxychloroquine are all

DMARDs

etanercept (Enbrel) infliximab (Remicade) Adalimumab are all

biologics (TNF)

suffix for most biologics

**-mab** *also cept*

mc DMARD

methotrexate

starting dose for MTX

7.5 mg PO weekly

pt should see improvement w. DMARD w.in

2-6 weeks

contraindications for DMARDs (3)

pregnancy liver dz heavy etoh severe renal impairment

s.e of MTX (2)

GI upset stomatitis

monitoring labs for MTX

CBC → cytopenias LFTs → hepatotoxicity

all pt's on MTX need to take

folic acid OR leucovorin calcium)

folate prevents \_\_

hematologic s.e

TNF (biologics) inhibitors can be administered (2)

SQ IV

biggest barrier to TNF tx

expensive!

major concern w. TNF inhibitors

higher risk for serious bacterial infxn ex ganulomatous infxn

mc granulomatous infxn associated w. TNF inhibitors

reactivation of TB

screening test for all pt's starting TNF inhibitor

latent TB

t/f: TNF inhibitors have a lot of s.e

false! *few s.e, work very well, well tolerated*

1st choice for TNF inibitor

etanercept

all pt on TNF inhibitor should be followed by

rheumatologist

how do you monitor functional status of RA pt

pick a scale and stay consistent

RA pt need f.u radiographs every

2 years

highest cause of mortality in RA pt

CV dz from chronic inflammation

poor prognostic factors for RA (4)

RF OR anti-CCP (+) extraarticular dz functional limitation erosions on radiograph

Rheumatoid Arthritis Flashcards

(80 cards)